Healthcare Provider Details

I. General information

NPI: 1912458712
Provider Name (Legal Business Name): JENNIFER SNAWDER R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DE PAUL DR
BRIDGETON MO
63044-2512
US

IV. Provider business mailing address

12303 DE PAUL DR
BRIDGETON MO
63044-2512
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-6373
  • Fax:
Mailing address:
  • Phone: 314-344-6373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2016030949
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: